At SGH, our Cell Saver programme collects, cleans, and returns patients’ own blood during major surgeries — helping them recover faster, safer, and stronger, while reducing reliance on donor blood.

What started as a simple idea to help patients lose less blood during surgery has grown into a hospital-wide movement at Singapore General Hospital (SGH). The Intraoperative Cell Saver (ICS) programme ensures that patients use back their own blood safely during surgery. This not only reduces risks but also supports faster recovery, making it a perfect example of Value-Based Healthcare in action. 

What Is Cell Saver technology? 

The Cell Saver is not new — it is an established technique that has been used in hospitals around the world for many years to help patients conserve their own blood during surgery. 

“The Cell Saver works a bit like a recycling system for blood,” explains Dr Tan Yan Ru, Senior Consultant, Anaesthesia. 

“During big operations where patients are expected to lose quite a bit of blood — such as joint replacements, spinal, vascular and obstetric surgeries — the machine collects the blood that would normally be lost, cleans it, and gives it back to the patient, all safely and under sterile conditions.” 

It is used mainly for surgeries with significant blood loss, because that is where it can make the biggest difference. For smaller procedures, the blood loss is usually minimal and does not warrant the use of this technology. 

“But for major operations that lose significant amount of blood”, says Dr Yan Ru, “it can be life-changing - especially for patients who might otherwise need large amounts of donor blood. Donor blood transfusions have risks of immediate and delayed complications including allergic and immune reactions or serious ones like difficulty breathing. With the cell saver, patients can use back their own blood with fewer complications and have a smoother recovery. Patients often recover faster and feel stronger after surgery, because their bodies do not have to adjust to the foreign donor blood.   

Why SGH introduced ICS 

“It began with conversations on how to give patients better and safer care,” says Dr He Yingke, Consultant, Anaesthesia, one of the early champions of the programme. 

“When patients receive donated blood, there is always a small risk of complications — such as fever, allergic reactions, or, in rare cases, infections like hepatitis B, hepatitis C or HIV. There is also a small chance of bacterial contamination.” 

“With ICS, patients get back their own blood, which is much safer and better tolerated by their bodies. Their immune systems recognise it immediately, so there is no mismatch or risk of serious reactions. And since blood is a precious and limited resource, using ICS also helps conserve donor blood for more patients to use.” 

Big gains for patients and the hospital  

“The biggest win is for our patients,” says Dr Yan Ru. “Patients tend to do better after the operation, as they retain more of their own red blood cells, which carry oxygen to help tissues repair. In short,  ICS helps with patient's blood health, reduces the risks during surgery and enable patients to return to daily life sooner.” 

She adds, “Since launching the service in April 2023, we have also seen encouraging results at the hospital level. For major surgeries, the use of donor blood has dropped by a third — from three packs per patient to just two. That is safer for patients and has also saved the hospital more than S$400,000 in costs from a reduced need to collect, store, and administer donated blood. It also means we are using our blood supplies more efficiently, with less wastage.” 

OT AU nurses and anaesthetists including three ICS team members. ( Front row starting second from right) Dr He Yingke, Ms Fu Jing, Dr Tan Yan Ru  

Making it happen 

Explains Ms Fu Jing, Assistant Director of Nursing (ADN), Major Operating Theatre, “In the past, only vendors or perfusionists could operate the Cell Saver, which sometimes meant support was not always available when we needed it. By training nurses to run the service, we made it more reliable and available for more patients.” 

She adds, “Our nurses are proud to be part of this. They have gained new skills and confidence, and it is meaningful to know we are literally returning something precious — their own blood — to our patients.” 

Spreading the word  

“The ICS team, co-led by Dr Yan Ru, Dr Yingke, and ADN Fu Jing, has been busy promoting the service across different departments,” shares Esther Chng, Senior Assistant Manager, Office of Value-Based Healthcare, who provides data analytics and administrative support. 

“We have held roadshows and training sessions to show how ICS benefits patients and improves efficiency. Using data, we have also shown clear results — safer surgeries, fewer transfusions, and smarter use of blood supplies.” 

(From left) Dr He Yingke, Ms Esther Chng, Dr Tan Yan Ru during an ICS roadshow for surgeons  

Dr Yingke adds, “Seeing how well ICS worked encouraged us to look at the bigger picture — how we manage blood for patients throughout their entire surgical journey. Our surgical colleagues, especially those in high-blood-loss areas like orthopaedics surgery, have been really supportive.” 

A culture of safer, smarter care 

Esther sums it up nicely, “What started as a novel way to conserve blood during surgery has grown into a hospital-wide commitment to safer, smarter, and more sustainable care. It really shows how innovation and teamwork can make a lasting difference — for patients and the hospital alike.” 

“We would like to take this opportunity to offer our special thanks to members of the ICS team: 

Dr Pang Hee Nee, Dr Jiang Lei, A/Prof Reuben Soh, Dr Eric Liu (Orthopaedic Surgery) 

Dr Shawn Lee (Vascular Surgery) 

A/Prof Yong Tze Tein, A/Prof Devendra (Obstetrics & Gynaecology) 

A/Prof Ang Ai Leen, A/Prof Tien Sim Leng (Haematology)

A/Prof Hairil Rizal Abdullah (Value Driven Care) 

DD Ms Goh Meh Meh, DD Ms Shirlena Wong, CN Ms Ng Gaik Nai (Nursing) 

A/Prof Ruban Poopalalingam (Group CMB) 

National Heart Centre Perfusionist Team ” 

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